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Review of NCDs:
Current Situation &Future Prospect
Orratai Waleewong
Health Promotion Policy Research Center (HPR)
International Health Policy Program (IHPP), Thailand
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Outline
• Global Epidemic of NCDs
• NCDs and Socio-economic development
– Poverty and productivity
– MDGs
• Global movement on NCDs
• Best Buy Intervention: Policy and intervention
to prevent and control NCDs
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Global Risks Landscape 2013
Impact if the risk were to occur
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(World Economic Forum)
The Dangers of Hubris
on Human Health
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Likelihood to occur in the next
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Global Epidemic of NCDs
•
•
NCDs caused  36 million deaths (60 %) of global deaths (2008)
 80% of these occur in developing countries
Annual number of deaths in the world
25 million
2.3M
Injuries
20 million
6.8 M
Other deaths from NCDs
3.7M
Premature deaths from
NCDs (below age of 60),
which are preventable
2.3M
15 million
10.2M
13.6M
10 million
Communicable diseases,
maternal, perinatal and
nutritional conditions
0.5M
5.9M
0.6M
3.3M
3.0M
0.9M
High-income
countries
1.1M
Upper
middle-income
Source: The Global Burden of Disease 2004
3.3 M
3.0M
Lower
middle-income
Low-income
countries
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10 leading diseases & injuries and 10 leading risk factors
based on percentage of global deaths and DALYs, 2010.
NCDs account for
65.5% of all deaths,
54% of DALYs
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Source: Institute for Health Metrics and Evaluation, ‘The Global Burden of Disease: Generating Evidence, Guiding
Policy: 2012.
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NCDs mortality by countries (2008 estimates)
% NCD deaths
(all ages)
% NCD deaths under
age 60
Males
Female
Australia
Bangladesh
90
52
13.4
37.5
9.2
38.7
Bhutan
53
32.5
32.6
China
India
Indonesia
83
53
64
22.8
38.0
33.9
17.4
32.1
26.3
Japan
Myanmar
80
40
11.6
32.4
7.0
26.3
Thailand
Vietnam
71
75
32.3
26.4
25.0
19.4
World Health Organization - NCD Country Profiles , 2011.
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Poverty contributes to NCDs
and NCDs contribute to poverty
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NCDs undercut the attainment of the MDGs
• Poverty: Household income is
spent on health care for NCDs,
medicines, tobacco and alcohol
use
• Hunger: Underweight children
and overweight adults are
often found in the same
households
• Maternal health: Malnutrition
increases the risk of gestational
diabetes and poor maternal
health, high prevalence of
cervical cancer (300,000 a year)
• Child health: Malnutrition in
pregnancy is associated with a
vulnerability to obesity,
cardiovascular disease and
diabetes later in life
• Education: NCD-related costs
displace household resources
for education
• HIV/AIDS: Increases the risk of
cancers, and ARVs increase
the risk of cardiovascular
diseases
• Tuberculosis: Tobacco and
alcohol use, and diabetes are
associated with TB deaths
• Essential drugs: Cost-effective
medicines to treat NCDs are
available in low-cost generic
forms, but remain
inaccessible and unaffordable
to most who need them
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Cost of inaction Vs Cost of action
The cumulative economic lost
output in developing countries
associated with NCDs
The average cost for LMICs to scale
up action by implementing the “best
buy interventions”
US$ 7 trillion
US$ 170 billion
over 2011-2025
for 2011-2025
• US$ 500 billion per year
• US$ 25 in LICs, 50 in LMICs
& 139 in UMICs
US$ 11.4 billion per year
US$1 per capita in LICs, 1.5 in LMICs
& 3 in UMICs
4 NCDs X 4 common risk factors
Chronic respiratory disease
Unhealthy diet
4 NCDs
Harmful use of alcohol
4 Risk factors
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Tobacco use
Cardiovascular disease
Diabetes
Physical inactivity
Cancers
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What is driving the NCD epidemic?
Social
Determinants
of Health
Global action against NCDs
ECOSOC
Doha Declaration on
NCD & Injuries
UNGA High-level Meeting on the
prevention and control of NCDs
A/RES/66/2
Political Declaration on NCDs
WHA61.14
WHA53.17
Global Strategy
for the
Prevention and
Control of NCDs
WHA60.23
Implementation
Global Strategy
Action Plan on the
Global Strategy for
the Prevention and
Control of NCDs
2008-2013
WHA64.11
Moscow
Declaration
WHO Global
Status Report on
NCDs
WHA66.10
WHA56.1
WHA63.14
WHA57.17
WHA63.13
Global Strategy
on Diet,
Physical Activity
and Health
Global Strategy to
Reduce the
Harmful Use of
Alcohol
A Comprehensive
global monitoring
framework
Marketing of
food &
non-alcoholic
beverages to
children
Global Action Plan
2013-2020
Options & timeline for
strengthening and
facilitating
multisectoral action
2000 2003
2004
2007 2008 2009
2010
2011
2013
UN High-level Meeting on NCDs
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(19-20 September 2011, New York)
It was only the 2nd time in history that the UN
General Assembly discussed a health issue
113 Member States
34 Presidents & Prime-Ministers
3 Vice-Presidents & Deputy Prime-Ministers
51 Ministers of Foreign Affairs and Health
11 Heads of UN Agencies 100s of NGOs
Political Declaration
on NCDs
(A66/RES/2)
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UNGA High-level Meeting
on the prevention and control of NCDs
Political Declaration on NCDs (A66/RES/2)
• Establish multisectoral national plans by 2013
• Integrate NCDs into health-planning processes and the national
development agenda
• Promote multisectoral action through whole-of-government approaches
• Set national targets and measure results
• Increase domestic resources
•Head quarter
•WHO Regional Offices
•Member states
•Develop a global monitoring framework and targets
•Develop a global implementation plan 2013-2020
•Provide technical support to developing countries
•Identify options for multisectoral actions
•Coordinate work with other UN Agencies
•Measure results and report
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World Health Organization (WHO)
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Vision:
The promotion of equity, universal access,
and self-reliance in health development
Strategies to deliver on this vision:
Health systems and capacity building
NCDs, mental health & disabilities
Health security
Health development for poverty reduction (by
accelerating MDGs)
 Improving access to medical products
 Improving performance through reform
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


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WHO reform: Global Programme of Work
(Draft 12th)
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Rio+20 United Nations Conference on
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Sustainable Development [June 2012]
“ We understand the goals of
sustainable development can only
be achieved in the absence of a high
prevalence of debilitating
communicable and NCDs, and
where populations can reach a state
of physical, mental and social wellbeing. ” (paragraph 138)
“ We acknowledge that the global
burden and threat of NCDs
constitutes one of the major
challenges for sustainable
development in the 21st century. ”
(paragraph 141)
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UN Task Team on
the post-2015 UN development agenda [June 2012]
“ The MDGs did not adequately
address … increase in NCDs . ”
(paragraph 19)
“ Priorities for social development
and investments in people
would include: … NCDs. Access
to sufficient nutritious food and
promotion of healthy life styles
with universal access to preventive
health services will be essential to
reduce the high incidence of NCDs
diseases in both developed and
developing countries” (paragraph
67)
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Global Action Plan
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for the Prevention and Control of NCDs 2013–2020
Objectives
1. To raise the priority accorded to the prevention & control of NCDs in
global, regional and national agendas and internationally agreed
development goals, through strengthened international cooperation and
advocacy
2. To strengthen national capacity, leadership, governance,
multisectoral action and partnerships to accelerate country
response for the prevention & control of NCDs
3. To reduce modifiable risk factors for NCDs and underlying social
determinants through creation of health-promoting environments
4. To strengthen and orient health systems to address the prevention
& control of NCDs and the underlying social determinants through
people-centred primary health care and universal health coverage
5. To promote and support national capacity for high-quality
research and development for the prevention & control of NCDs
6. To monitor the trends and determinants of NCDs and evaluate
progress in their prevention & control
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NCDs is preventable !
The package of low-cost "best buys" interventions exist
, but implementation in developing countries is still weak
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Implementing low-cost workable solutions in
developing countries could prevent most
premature deaths from NCDs
2/3 + 1/3
• Implementing cost-effective interventions that
reduce exposure to NCDs risk factors of
populations will contribute up to 2/3 of the
reduction in premature mortality.
• In addition, health systems that respond more
effectively and equitably to the health-care
needs of people with NCDs can reduce
premature mortality by another 1/3 up to 1/2.
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Population-based interventions addressing NCD risk
factors: “Best buy” & “Good buy” interventions
Best buy
Good buy
Tobacco use
•Protect people from tobacco smoke
•Warn about the dangers of tobacco
•Enforce bans on tobacco advertising
•Raise taxes on tobacco
• Offer counseling to smokers
Harmful use
of alcohol
•Restrict access to retailed alcohol
•Enforce bans on alcohol advertising
•Raise taxes on alcohol
• Enforce drink-driving laws (breathtesting)
• Offer brief advice for hazardous
drinking
Unhealthy
diet
•Reduce salt intake
•Replace trans-fat with
polyunsaturated fat
•Promote public awareness about diet
•Restrict marketing of food& beverages
to children Replace saturated fat with
unsaturated fat
•Manage food taxes & subsidies
•Offer counseling in primary care
•Provide health education in worksites
•Promote healthy eating in schools
Physical
inactivity
•Promote physical activity (mass
media)
•Promote physical activity
(communities)
•Support active transport strategies
•Offer counseling in primary care
•Promote physical activity in worksites
•Promote physical activity in schools
Infection
•Prevent liver cancer via hepatitis B
vaccination
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Risk factor
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Risk factor
Best buy
Good buy
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Individual-based (Health care) interventions
addressing NCD risk factors: “Best buys”
• Counseling & multidrug therapy
(including glycemic control for DM) for
people (≥30 years), with 10-year risk
of fatal or nonfatal cardiovascular
events ≥ 30%
• Aspirin therapy for acute myocardial
infarction
• Counseling & multidrug therapy
(including glycemic control for DM)
for people ( ≥ 30 years), with a 10year risk of fatal and nonfatal
cardiovascular events ≥ 20%
Cancer
• Cervical cancer screening (VIA), &
treatment of pre-cancerous lesions to
prevent cervical cancer
•Breast cancer – treatment of stage I
•Breast cancer – early case-finding
through biennial mammographic
screening (50–70 years) & treatment
of all stages
•Colorectal cancer-screening at age
50 and treatment
•Oral cancer – early detection and
treatment
Respiratory
disease
• Treatment of persistent asthma with
inhaled corticosteroids and beta-2
agonists
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Cardiovascular
disease (CVD)
& diabetes
Early detection & care, using cost-effective & sustainable health-care interventions
>> integrate into primary health care
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Orratai Waleewong, B.Pharm, MSc
Health Promotion Policy Research Center (HPR)
International Health Policy Program (IHPP)
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orratai@ihpp.thaigov.net